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Ciprofloxacin/levofloxacin Radiation recall dermatitis: case report

A 58-year-old woman developed radiation recall dermatitis (RRD) during treatment with ciprofloxacin and levofloxacin for bronchitis. The woman presented with acute onset of skin changes to the left breast. She had been diagnosed with the left breast ductal carcinoma in situ 5 years prior to the presentation and had undergone a lumpectomy with clear margins, followed by adjuvant whole breast radiation therapy without complications. Grade 1 hyperpigmentation and erythema at expected levels were noted on completion of the radiation and were found to be resolved at a 1-month follow-up. She was then initiated on tamoxifen which was replaced by exemestane due to increased triglyceride levels [aetiology of increased triglycerides not stated]. She tolerated exemestane well and was maintained on exemestane. She had been feeling well, but developed severe, sudden painless bruising to her left breast. Examination showed diffuse skin discolouration, rash and bruising of the left breast predominantly at the dependent portion of her breast. She was afebrile with no leucocytosis. Ultrasound and mammogram showed diffuse whole breast skin thickening, with no suspicious calcifications or masses. A skin punch biopsy showed fibrosis and vascular ectasia with thrombosis, and atrophic epidermis with mild patchy spongiosis on background of radiation changes. Her medical history revealed an episode of bronchitis treated 2 months prior to her presentation with a course of ciprofloxacin followed by levofloxacin [routes and dosages not stated]. RRD was suspected. The woman received treatment with clobetasol. Within two weeks of the treatment initiation, the skin changes to the left breast completely resolved. Rafiroiu S, et al. Quinolone-induced radiation recall dermatitis in breast cancer patient. Breast Journal 26: 1407-1408, No. 7, Jul 2020. Available from: URL: http:// doi.org/10.1111/tbj.13756

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Reactions 22 Aug 2020 No. 1818